PPIC/JH98 International Conference

Electronic Mail Registration

(Kanji -code is not acceptable)

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Instructions:
　Please complete this form and use the Submit button at the bottom of the page to submit your registration. Please remember to include your e-mail address so that a receipt of confirmation can be sent.


Domestic/Overseas:　Domestic Overseas

Prof.　 Dr. 　Mr. 　Mrs.　 Ms.　 Miss

Name:
　, ,

Postition/Title:
　

Company/Affiliation:
　

Address:
　
　　City:
　　　
　　State/Province:
　　　
　　Country:
　　　
　　Zip/Postal Code:
　　　

Phone:
　
Fax:
　
E-Mail Address:
　

Registration ：

　Registration Fee :
　　　SEPJ member　：　20,000 Yen
　　　Non member 　 ：　25,000 Yen
　　　All overseas 　 ：　20,000 Yen
　　　Student　 　 　：　10,000 Yen

　Conference Reception :

　　　　Ticket 　　　 　 ： 　5,000 Yen

　　　I will attend　　I will not

　All payments will be accepted at on-site registration desk.
　　　（with Japanese yen only）

　Press Submit button for pre-registration !

　　　　

　Thank you for your cooperation.
　We are looking forward to meeting you on the Conference.

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